Ukuqonda Ukusebenzisa Kukhono Lokugcina Isifunda

Imiphumela Yokuqiniseka Kwemithambo Yokunqula Okungafanele Ngokuphepha

Ukwenza kahle umkhawulo wokuphepha okungafanele ngokuphepha nokulungisa indawo yokunqula

Ukuziphatha ngokuzimisa kwezisekelo zokusebenza ngokupheleleyo kuyisisekelo xa kusebenziswa injekshini yamanthezi engaphansi kokugcina isikhathi esihle. Qala ngokuhlanza amakhanda ngokusetshenziswa kwemithwalo yamahloko noma sabononi esebenzisa amasimbi okuhlanza amakhanda. Yenza amaglova angaphansi kokugcina isikhathi esihle futhi uhlola konke ukubhala kwezinkotho ukuthi kuyisikhathi esihle, kungabi nesibhakabhaka, futhi kungabi nesikhathi sokugcina isikhathi esihle—susa konke okungabi nesikhathi sokugcina isikhathi esihle ngokushesha. Seta indawo yokusebenza ngokupheleleyo emanzini engekhulu, emhlophe, futhi phezu kwezinyawo ngokusetshenziswa kwemphakathi yamanthezi; qinisa ukuthi kunezindawo ezingu-1 inch (2.54 cm) ezikwesibhakabhaka sezimpakathi, ngoba le zindawo ziyizindawo ezingaphansi kokugcina isikhathi esihle. Vula iphakethi yenjekshini ngaphandle kokukhumbula izinto zangaphansi—qondla kuphela iphakethi yangaphandle. Uma indawo yokusebenza iyazimisa, zama indawo yokunqamuka ngokusetshenziswa kwesilika se-chlorhexidine-alcohol ngokusetshenziswa kwesikhathi sokufana nokuzimisa ngokupheleleyo. Vumela isilika sokuvutha ngokupheleleyo; isilika esishele singathwala amabacteria kuma-tissues amaningi. Ngakabili ukubhala indawo emva kokuzimisa. Uma kudingeka ukubhala kabusha, sebenzisa amaglova angaphansi kokugcina isikhathi esihle noma uzimise kabusha indawo. Lezi zisekelo—kunye nokugcina isikhathi esihle kwezindawo ezingaphansi kokugcina isikhathi esihle futhi ukusonga kwamafutha—zisetha isibhakabhaka esihle sokuvutha kwezibhakabhaka. Ukuqonda kubonisa ukuthi ukusebenzisa lezi zisekelo ngokupheleleyo kunciphisa ukuvutha kwezibhakabhaka zezivascular ngaphezu kwe-50% (CDC 2023).

Ukugcina ukuthi kubhekeleke kwezinye izikhathi zokubhlokisa isipina, i-epidural, nokubhlokisa amaswidi wezinye izindawo

Izindlela zokuphatha izinyathelo zokunqamula emaphakathini—ukunqamula kwe-spinal, ukunqamula kwe-epidural, nokunqamula kwemithambo yezinyathelo—zidinga ukuziphatha ngokupheleleyo ngokuphatha kwezinto ezinamandla ukuze kuvikekwe izifo ezingavumelekileyo njenge-meningitis noma i-epidural abscess. Sebenzisa kuphela amaphathi angu-1 osebenzayo, amaphathi okunqamula okwenzelwe ngendlela engeyona phakathi yasekhaya; ungasebenzisi phakathi amaphathi okunqamula angu-1. Ngokulungiselela, bheka umkhonto, isikhumba, isikhumba sokunqamula esinamandla, nokugxuma. Vula iphakethi yamaphathi ngaphezu kwesikhathi sokusebenzisa futhi ungakhubeki amaphathi kusuka kumaphathi anganamandla. Kuma-neuraxial procedures, gcinani istylet endaweni yakho kuze kube ngepuncture, futhi ungakhubeki isikhumba samaphathi emva kokuhlanganiswa. Ngokufaka i-continuous epidural catheter, sebenzisa kuphela amaphathi okunqamula noma amagloves okunqamula, futhi yisikhumba ngaphansi kwesikhumba esishibhile, esinamandla. Kuma-ultrasound-guided peripheral blocks, sebenzisa isikhumba esinamandla sokuphatha isikhumba futhi isikhumba sokunqamula esinamandla, futhi yisikhumba sokuphatha isikhumba sokuphatha ukuze kuvikekwe ukungena kwezinto ezinamandla. Yenza isikhathi sokuphatha sifanele, futhi uma ukuphatha kwezinto ezinamandla kuhlanganiswa ngalokho, thabatha amaphathi futhi qala kabusha. Ungasebenzisi phakathi amaphathi—even on the same patient—uma ukuphatha kwezinto ezinamandla kungahlanganisiwe. Iziphakade zokuphatha zikubonisa ukuthi ukuphatha kwezinto ezinamandla ngokupheleleyo kunciphisa izilingo zokunqamula kwezinyathelo zokunqamula kusukela kwezinyathelo zokunqamula kusukela kwezinyathelo zokunqamula (Br J Anaesth 2020).

Kungani Izikhali Zokugcina Ukugcina Kuzo Ziyakwenzeka Ngokwekuphela Kwezinye Ikhanda

Ukuhamba kwezikhali zokugcina ukugcina kuzo zezinye ikhanda zokugcina kuzo akuyiyo kuphela ukuthandwa kwesayensi—kuyiyo indlela yokugcinwa okubalulekile ekukhishoneni umthwalo wokugcina kwezinye ikhanda okunakwenzeka ngokuvamile. Ukuthembeka kakhulu kulesi siphumo sikugcina abantu nabaprofesi yonke kusindiswa kwezindlela eziphambili zokugcina.

Izibonelo zokuxhuma ukusebenzisa izikhali ngokuphinda kuzo nokuthumela amaphathogeni okwesifuba

Ukusebenzisa indawo yokuqondisa kabusha—noma kuphela kumuntu oyedwa noma kusuka kweviali yemithambo yomuthi—kuyisibonelo esikhuluphile ukuthi kubangela ukuphuma kwemihlaba yaseHepatitis B (HBV), yaseHepatitis C (HCV), nokuthi kubangela uHIV. Amaphenomena okutholakala akhuluphile kubonisa ukuthi indawo yokuqondisa eyodwa noma isyringe esiyodwa esisebenziswe kubabili noma ngaphezu kwalokho sibonakalisa ukuthi kubangela ukuphuma kwemihlaba yaseHepatitis yobuhlungu obungafuneka uma kusetyenziswa ngokuphelele indawo yokuqondisa eyodwa kuphela. Amaphenomena emakhlabeni ayasho ukuthi amaviri amahle amahle asebhaleni abanake kuzo indawo yokuqondisa noma isyringe emva kokukhona kweblood noma kwe-tissue. Umhlangozi waseCDC owadlula izihlaba zezinkulungwane ezintathu nezintlanu ezingaphansi kwezindawo zokusebenza kwezempilo ezingaphansi kwezihospital phakathi kwe-2001 no-2011 wabonakalisa ukuthi ukusebenzisa isyringe noma indawo yokuqondisa kabusha yisibonelo esiphakathi kwezinkulungwane ezintathu nezintlanu zezihlaba. Ukuthi kunezinkinga kungakwazi ukuthi kungabi ngezinye: umthwalo omnye ungathola abantu abaningi. Kukuziphatha kwezimpilo zokugcina ubuhlungu, njengoko kwenziwa kwe-spinal noma kwe-epidural, iziphumo zingaba yokuqondisa i-bacterial meningitis noma i-epidural abscess—izifo ezinokuthi zilahle umuntu, futhi zidinga ukuthi zihlanganiswe ngokuphelele. Ukuthi sisebenzise indlela yokuthi “indawo yokuqondisa eyodwa, umuntu oyedwa, isikhathi esodwa” sivula le ndlela yokuthi izifo zihlanganise kabusha, futhi sivumela ukuthi indawo yokuqondisa yezimpilo zokugcina ubuhlungu kufanele isebenzise ngokuphelele futhi asifanele kubuyiselwa.

Amazwi okuhlanganisa (CDC, WHO, ASA) ngamaphoyinti asebenzayo esihlwayini sokubhiza isifuba

Amaphakamiso amakhulu okuhle kwezintloko zazibhalisa indlela yokusebenzisa umsila ngokwehlanzela njengemithombo eyodwa. I-Centers for Disease Control and Prevention (CDC) ibhekisela ngqo ukuthi umsila wokuphatha, omnye nesikhala esingasiza, kufanele sisebenzise ngalokho lokugcina—kanye nokuthi izinkampani zokusebenzisa ngokwehlanzela azifanele ukuzilungisa futhi ukubuyisepha emsebenzini kumuntu omnye. I-World Health Organization (WHO) isondela lokho kumkhakha wakhe wokugcina umsila phakathi kwemizwi yonke, ibhekisela ukuthi ukubuyisepha umsila nekhala kungasafani kanye nokuthi kuyisithembiso kumkhakha wokuhle kwezintloko. I-American Society of Anesthesiologists (ASA) isondela lemiyalelo kumithombo yakhe yokusebenza kwe-anesthesia yezindawo, ibhekisela ukuthi izimsila ezihlaziwe kufanele sisebenzise ngalokho lokugcina ngalokho lokugcina kuzo zonke izibizo zokuhlaza kwezindawo. Lezi zimithombo zibonisa ukuthi kukhona ukuxhumana kwezinye izinkampani ukuthi akukwazi ukulungisa ngokuphelele izimsila ezingaphansi kwezindawo—kanye nokuthi izimsila zokuhlaza zingahleli kwezindawo zingabonakala kwezindawo zokulungisa futhi zingayikho kwezindawo zokuhlaza. Ukuzinikela akukho okunakho; kuyinto ekufanele kwenziwe ngokwemithombo kanye nokuthi kuyinto ekufanele kwenziwe ngokwemithombo yokuqonda ukuthi kufanele kwenziwe ngokuphelele kuzo zonke izindawo zokusebenza ukuze kuvikekwe ukuthi izivivinyo zokuhlaza kwezinye izinkampani ziyophinda zibeke kumuntu omnye.

Ukungakhathalisi Kwezinto Ezihlukene Kusendleleni Yokusebenza Kwemithambo Yokuqinisa

Ukuhlala kwezinto eziphakathi zokusebenza kwemithambo yokuqinisa kuyisibonelo esikhulu sokuthi ukuphatha kahle umthambo wokusebenza ngokuphelele ayikwazi ukugcina ukuzimela kahle. Noma uma umthambo wokusebenza uphathwa ngokuphelele, iziphetho zezinhlelo zokusebenza zokuzimela kuzo zokwenzeka kahle ukuthi izilwane zokuhlanza zingafika. Izindawo eziphambili zokuhlukaniswa kwezilwane zokuhlanza ziyizindawo ezinamaphuzu amaningi, izivili ezinamaphuzu amaningi, nokuthi izinkampani ezinamaphuzu amaningi. Izindlela ezincane kodwa ezenziwa ngokubhekisele kubizo bokuxhumana kubona kuzoba yinkimbinkimbi enkulu yokuhlukaniswa kwezilwane zokuhlanza.

• Ukubambisana Kokuphatha Amadla : Yenza ukuchitha amadla ngokushesha kabusha ngaphambi kokuthintela umthambo wokusebenza okuzimelwe noma isikhumba sokuthinta sokuthinta—akukho kuphela ngokufika kusendleleni yokusebenza. I-CDC ibhekisele kuthi ukuphatha amadla ngokusebenza kwe-alcohol kuyisibonelo sokuthi kubeka isikhumba sokuthinta sokuthinta kusenziwa ngokuphelele.
• Ukuphatha Kwe-Stopcock Nezindawo Zokuthinta : Chitha zonke izindawo zokuthinta ngapha kwe-70% isopropyl alcohol futhi uzame ukuzicitha ngokuphelele ngemizuzu eyishumi nesibili. Izindawo ezingachithiwe zingabona izilwane zokuhlanza ezingazimela ezinakwenzeka ukufika kusendleleni yokudlula kwemithambo.
• Umthambo omunye, isikhumba esinye, isikhathi esinye : Sebenzisa isikhombisa sase-anesthesia esisemthakathini ne-injekshini yayo ngokwehle kumuntu omunye futhi kuzo zonke izindlela zokufinyelela. Ukubuyisela isikhombisa esisebenziswe kusuka kwe-vial noma kwe-IV line kusetha konke ukusebenza kusenziwa ngokungafanele, kusindisa izinkulungwane zezinkinga zokuhlanzwa ezizange zizweni phambi kokwenzeka.
• Ukuphakanyiswa kwesikhundla : Hlala uhlakaniphe isikhundla sesikhombisa sase-anesthesia ukuze siyihlanze futhi siyibhale. Sibhekise isikhombisa esisebenziswe, isithakazelo, nokuthengiswa okusha ngokucacile. Umsebenzi wokuzwa okwenziwe ngo-2022 wabonisa ukuthi i-67% yamaphuzu ase-anesthesia ayebenziwe ngokungafanele ngokuthi kunezikhundla zokubhala ezingahlanziwe ngokugcwele emva kokuphendula umsebenzi uma kubhekise isikhundla sokusebenza.

Lapho kubhekiswe kumsebenzi wokuzenzakalela, lezi zinhlobo zomsebenzi zihlalisa isikhombisa sase-anesthesia esisemthakathini kusukela lapho kuvulwa kuya kufinyelela kumuntu—kuvula indlela yokuhlanzwa kwezinye izinto.

Ukusebenzisa Ngempilo Neukuthiwa Kwezikhombisa Zase-Anesthesia Zesisemthakathini

Izimiso zokuhlinzekile kwezikhombisa: kusukela ukuvula kuze kuthiwa kwezikhombisa

Injekshini yokuqinisa amandla ayisilili kufuneka ibe nezindlela zokuphepha ngokuphelele emva kokukhulula isikhumba. Khulula isikhumba ngokushesha kabusha phambi kokusebenzisa, ngokusebenzisa umsebenzi wokuphakamisa ukuze usivikeleke kwezinkinga zokubhisha ngokungafanelekile. Uma ukhulula kabusha kungafanele, sebenzisa kuphela indlela yokugcina ngolimi omunye; ukhulula kabusha ngamadlamu amabili kuyisibonelo esiphambili sokubhisha injekshini. Emva kokubeka isibhishiwe noma injekshini, thabatha injekshini ngokushesha kumkhumbi wokubhisha okwamukelwa ngu-FDA, ungathabathi njengoba kusenziwa ngokushesha. Ungathabathi injekshini eyasebenziswe kusendaweni yokusebenza noma ekhabinethini. Amakhumbi kufuneka abe neminyaka yokugcina, abe nemithubi yokubhisha, abe nemithubi yokuvula, nokuthi abe neminyaka yokugcina ngaphakathi nangaphandle, futhi kufuneka kubuyiselwe uma kufika ema-2/3 kwenkulu yalo ukuze kuvikeleke kwezinkinga zokubhisha ngokuphelele. Izimboni zokuphatha izinto zokuphatha kwemihlaba zibonisa ukuthi ukuthabatha ngokushesha kunciphisa isibhisho sokubhisha ngokuphelele ngo-40%, ukuvikeleka kwebhodi yezimpilo zomphathi wokusebenza noma abasebenzi bokuphatha izinto zokuphatha emva kwabo. Ukuzimela ngokuphelele kule ndlela yokuzimela kuyisibonelo esisodwa esiphelele sokuvikeleka kwezinkinga zokuhlanzwa kwezinhlobo zokuphatha izinhlobo zokuphatha kwezimpilo zokusebenza.

Isikhombisi Sokuqala

Izinyathelo zokusakaza kwe-sterile field ziyini?

Qala ngokuhlanza amadla, sebenzisa amaglova e-sterile, lungezi indawo yokubhala ukuthi iyisivumelwano esihle, sakha i-sterile field phezu kwezandla ngokusebenzisa i-sterile drape, futhi gcinani isikhundla esingasakazi sengxenye yendawo yokubhala. Qiniseka ukuthi iphakheji yenjili yavulwa ngaphandle kokuthi kubhalekile izinto zangaphakathi.

Kungani ukusebenzisa kabusha injili kubi?

Ukusebenzisa kabusha injili kuxhasiwe nokuqhubela kwamadoda amabili asebenzisa isangu kanye nezinhlobo zezinkomo zokuphatha isangu njenge-HBV, HCV, ne-HIV, nokuthi kubhekene nezindlela zokuphatha izinkomo zokuphatha isangu kanye nezinkomo zokuphatha isangu ezinokuthintela umuntu ngokukhula kwezinkomo zokuphatha isangu njenge-meningitis.

I-"one needle, one patient, one time" yithi ntoni?

Lithi usebenzisa injili yokuqinisa isangu ne-syringe esihle kanye nezinkomo zokuphatha isangu kuyiliphi na umuntu wokugcina umkhakha wokugcina, ngaphandle kokufuna kabusha amakhanda okuphatha isangu noma izinhlobo zezinkomo zokuphatha isangu ukuze ukungahlinzeka.

Ukwenza ntoni ukuhlakuleka ukungahlinzeka kwezinhlobo zokuphatha isangu?

Qinise ukuchitha amandla okuhlela phambi kokuthintela izinto ezingavunyelwe, thintela amaporti okukhupha ngemithambo yomshini wokufaka, sebenzisa izikhumba nezisilindzi esizimele, futhi qwalasela kahle izinkampani ezihle nazo zokusebenzisa.

Kufanele zithakelwe njani izikhumba zokugcina izinhloko zokubhala?

Thakela izikhumba ngqo emazinkampani zokuthakela izikhumba ezivumelwe ngu-FDA. Izinkampani kufanele zibe zingathwaliwa, zingabhekile, zingavulwa, futhi zibuyiselwe lapho zifika emithathu kwezine zokugcina.